Internet-Based Cognitive Behavioural Therapy Programme Tailored to Patients with Cardiovascular Disease and Depression: A Randomised Controlled Trial

Abstract

Background: Depression is a common cause of poorer well-being and prognosis in patients with cardiovascular disease (CVD). Yet there is a lack of effective intervention strategies targeting depression. We therefore evaluated the effect of a nurse-delivered and tailored internet-based cognitive behavioural therapy (iCBT) programme aimed at reducing depression in patients with CVD. Methods: A randomised controlled trial. Patients were recruited from medical or cardiology clinics at five hospitals in south-eastern Sweden. Patients were eligible if they were ≥18 years old, had CVD treatment, had not been hospitalised for CVD in the past four weeks, and had at least mild depressive symptoms. 144 patients were randomised 1.1 to nine-week iCBT (n=72) or an active control participating in an online discussion forum (ODF, n=72) with a block size of two. The primary outcome, depression, was measured by the Patient Health Questionnaire-9. Outcomes: In total, 65 patients in the iCBT group and 62 patients in the ODF completed the outcome measure. Using intention to treat analysis, iCBT compared to ODF had a moderate treatment effect on depression (mean group difference -2·34 [95 % CI -3·58 to -1·10], p=0·0003, effect size d=0·62). No patients were discontinued from the study due to high risk of suicide or deterioration in depression. Interpretation: Nurse-delivered iCBT can reduce depression in CVD patients enabling treatment for depression in their own homes and at their own preferences of time. Trial Registration Number:The trial is registered at ClinicalTrials.gov, NCT02778074. Funding Statement: This study received funding from the Swedish Research Council (2015-02600), ALF grants Region Ostergotland (LIO-600321 and LIO-687531) and Region Ostergotland, Strategic fund (LIO-719561). Declaration of Interests: None of the authors declare any competing interest. Ethics Approval Statement: The study was approved by the regional ethical review board in Linkoping Sweden (no. 2016/72-31).